Endometrial ablation

Menorrhagia can be treated by removal of the endometrial layer of the uterus. This can be achieved by destruction of the basal layer, so preventing menstruation. Subsequent blastocyst implantation and hence pregnancy is less likely, but both uterine and ectopic pregnancies have still occurred - contraception is still indicated.

Endometrial ablation (1,2):

• second-generation endometrial ablation should be considered as a treatment option for women with HMB and fibroids of 3 cm or more in diameter who meet the criteria specified in the manufacturers' instruction (2)
  
• in women with HMB alone, with uterus no bigger than a 10-week pregnancy, endometrial ablation should be considered preferable to hysterectomy (1)
• second-generation ablation techniques should be used where no structural or histological abnormality is present
  • impedance-controlled bipolar radiofrequency ablation
  • fluid-filled thermal balloon endometrial ablation
  • microwave endometrial ablation
  • free fluid thermal endometrial ablation

Advise women to avoid subsequent pregnancy and use effective contraception, if needed, after endometrial ablation.

Reference:

1. NICE (January 2007). Heavy menstrual bleeding.
2. NICE (March 2018). Heavy menstrual bleeding